CurrentAgency for Health Care AdministrationPolicy 11-W-00206/4

Managed Medical Assistance Program

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This policy authorizes specified Florida Medicaid expenditures under the Section 1115 demonstration, including managed care automatic reenrollment, Low Income Pool uncompensated care payments, and services for children and Healthy Start participants. It applies to the Agency for Health Care Administration and providers and managed care organizations involved in the demonstration.

Policy Summary

PayerAgency for Health Care Administration

PolicyManaged Medical Assistance Program

Policy CodePolicy 11-W-00206/4

Change TypeNo material change

Effective DateJul 31, 2014

Next Review DateNot specified

Key ActionManaged care organizations may automatically reenroll individuals who regain Medicaid eligibility within six months into their last managed care plan.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3Expenditure authorities identified

6 monthsAutomatic reenrollment period

2Program objectives identified

Authorized Demonstration Expenditures

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CurrentAgency for Health Care AdministrationPolicy 11-W-00206/4

Managed Medical Assistance Program

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Sign up for Agency for Health Care Administration Policy 11-W-00206/4 alerts

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Policy Summary

PayerAgency for Health Care Administration

PolicyManaged Medical Assistance Program

Policy CodePolicy 11-W-00206/4

Change TypeNo material change

Effective DateJul 31, 2014

Next Review DateNot specified

Key ActionManaged care organizations may automatically reenroll individuals who regain Medicaid eligibility within six months into their last managed care plan.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3Expenditure authorities identified

6 monthsAutomatic reenrollment period

2Program objectives identified

Authorized Demonstration Expenditures

Authorized demonstration expenditures

The following expenditure authorities are permitted under the Florida Managed Medical Assistance Program Section 1115 demonstration for the period July 31, 2014, through June 30, 2017.

ALL of the following

Automatic reenrollment expenditures: Expenditures for payments to managed care organizations when individuals who regain Medicaid eligibility within six months of losing it are automatically re-enrolled into the last plan in which they were enrolled.within six months of losing Medicaid eligibility
Permitted notwithstanding the limits on automatic re-enrollment defined in section 1903(m)(2)(H) of the Social Security Act.
Uncompensated care expenditures: Expenditures made by Florida for uncompensated care costs incurred by providers for health care services provided to uninsured or underinsured individuals.
For demonstration year 10 through June 30, 2016, and demonstration year 11 from July 1, 2016, through June 30, 2017; subject to the restrictions placed on the Low Income Pool, as defined in the Special Terms and Conditions.
Program services expenditures: Expenditures for Program for All Inclusive Care for Children services and the Healthy Start program.
Services must be previously approved under the 1915(b) waiver, control number FL-01, and described in Special Terms and Conditions 64 and 65.

Program and Payment Authorities

Billing Rule

Automatic reenrollment within six months

Managed care organizations may receive payments for automatically reenrolling individuals who regain Medicaid eligibility within six months of losing eligibility into the last plan in which they were enrolled, notwithstanding statutory limits on automatic reenrollment.

Billing Rule

Uncompensated care is subject to Low Income Pool restrictions

Providers may receive demonstration expenditures for uncompensated care costs incurred for health care services provided to uninsured or underinsured individuals. These expenditures are subject to the restrictions placed on the Low Income Pool, as defined in the Special Terms and Conditions.

Applies for demonstration year 10 through June 30, 2016, and demonstration year 11, July 1, 2016 through June 30, 2017.
Services must be provided to uninsured or underinsured individuals.

Billing Rule

Children’s and Healthy Start services

Expenditures are authorized for Program for All Inclusive Care for Children services and the Healthy Start program as previously approved under the 1915(b) waiver (control #FL-01) and described in Special Terms and Conditions 64 and 65.

Policy Summary

PayerAgency for Health Care Administration

PolicyManaged Medical Assistance Program

Policy CodePolicy 11-W-00206/4

Change TypeNo material change

Effective DateJul 31, 2014

Next Review DateNot specified

Key ActionManaged care organizations may automatically reenroll individuals who regain Medicaid eligibility within six months into their last managed care plan.

SourceLink

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